Monday, December 1, 2014

As I do the Green Belt course
I’ve been asking myself when and why physicians should be interested in
learning Lean? At first I struggled a little to find out how the physician’s
mindset could fit in with what I was learning – it is hard to extrapolate from
non-clinical material to a clinical world. I do think that Lean training for
physicians needs to be clinical and to that end will help push that forward as
my own agenda as best I can. But in thinking offhand as to why a physician
should learn Lean I came up with two salient reasons.

First, in practicing medicine
I’ve come to realize with such a demanding domain that everyone – yes, everyone
- needs help. For example, in comparing the not-so-remote system of written
orders versus computer order entry which can trigger one to remember more, I
feel the latter is better. No one wants to acknowledge that they don’t know or
remember everything – indeed there is a striking amount of cockiness in
physicians when it comes to assessing what they think they know concretely –
but having a standardized, computerized, evidence-based system in place which
helps one’s thought processes be non-omittingly comprehensive helps
non-threateningly alleviate this real issue. Expectedly, as good computer order
entry implementation is really a “mini-Lean” process, Lean methodology mirrors
computer order entry’s philosophy:namely
that clean standardization of processes due to an acknowledgment that what we
think we know isn’t always what actually is, is imperative for error-reduction.
Both entities refuse to rely solely on individual recall and perception for
progress with the knowledge that these are inevitably, routinely incomplete.

Second, in conjunction with
the above, I think that analyzing processes from the way one has always
analyzed them is less than fruitful. To be in medicine and to assume that one
has the answers to process issues because medicine is indeed different is
false. Actually, processes are often processes and it frequently takes an
outside perspective (not a consultative perspective, just an outside
perspective) to understand what one didn’t before. For a physician to learn
Lean is to currently step outside of the medical domain and learn something new
which then can provide a novel approach as to what to do with standard process
issues which have benefitted from Lean/Six Sigma elsewhere. Physicians above
all should step outside of their domain to learn Lean because they deserve to
be running the show of medicine, given how their sacrificial and hard-working existences
are impacted by it.

And as to the question of
when to learn Lean? Very possibly early on, in medical school. Lean appears to
be catching on in medicine, from hospital to hospital but still, it is a
piecemeal approach, one that largely hasn’t yet been embraced collectively by physicians
but more so by many ancillary to the medical process. This isn’t bad but again
as with so much in medicine, the power shouldn’t be given away – physicians
need to be overseeing process improvement which impacts them directly. With
this, it would be great if the thought process were already innate, and truth
to tell, the earlier one learns a subject, the more time one has to incorporate
it into his or her world experience. Medical school might be the optimal time
to tie in Lean training into the world of medicine, to get the creative juices
flowing.

So, those are the thoughts
for now, why and when physicians should learn Lean. Yes, Lean will likely be
beneficial for medical process improvement, especially if clinically oriented.
And with this, physicians, who are caught by edicts from so many directions,
would best be served by learning (at minimum) this one methodology, if not
more, early on and comprehensively to be able to assert greater sensible control
over their unique domain.